Transhepatic approach for cardiac catheterisation in children: initial experience

Aim-To assess initial experience of cardiac catheterisation in children by the transhepatic approach where conventional venous access is impossible. Patients and methods-Percutaneous transhepatic cardiac catheterisation was performed on six occasions in five children (three male) aged 4 to 36 month s (mean 17 months). All children had documented femoral venous occlusion an d all but one had occlusion of the superior vena cava. Ultrasound was used in five of the six procedures to help identify a large hepatic vein. A 4 F or 5 F sheath was introduced into the vein using the Seldinger technique. I n the fourth patient, hepatic venous access was obtained immediately withou t the assistance of ultrasound. Results-Percutaneous transhepatic catheterisation was successfully performe d at all six attempts. Total procedure time ranged from 120 to 200 minutes (mean 138 minutes) and screening time from 14 to 22 minutes (mean 16.8 minu tes). A serious complication was encountered in only one patient who had a retroperitoneal bleed after administration of thrombolysis for loss of femo ral arterial pulse. Conclusions-The percutaneous transhepatic technique can provide a safe alte rnative approach for cardiac catheterisation in children with multiple veno us occlusion. The procedure can be performed very simply using the Seldinge r technique and equipment normally used for conventional venous cannulation for cardiac catheterisation.